Provider Demographics
NPI:1346782588
Name:MARSH, BRANDON (ATC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MARSH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-1838
Mailing Address - Country:US
Mailing Address - Phone:708-315-4786
Mailing Address - Fax:
Practice Address - Street 1:OHARE CARGO AREA RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60666
Practice Address - Country:US
Practice Address - Phone:708-315-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer